CPT code 22305 is for the closed treatment of a spinal process fracture.
CPT code 22305 is for the closed treatment of a spinal process fracture. This means that the procedure involves treating a fracture in the bony projections off the back of the vertebrae without surgically opening the site.
For CPT code 22305 (Closed treatment of vertebral process fracture(s)), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Use this modifier if an evaluation and management service provided during the postoperative period is unrelated to the original procedure.
3. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: Use this modifier if a significant, separately identifiable E/M service is performed on the same day as the procedure.
4. Modifier 26 - Professional Component: Use this modifier if only the professional component of the service is being billed.
5. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed bilaterally.
6. Modifier 51 - Multiple Procedures: Use this modifier if multiple procedures are performed during the same session.
7. Modifier 52 - Reduced Services: Use this modifier if the service provided is less than usually required.
8. Modifier 53 - Discontinued Procedure: Use this modifier if the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
9. Modifier 54 - Surgical Care Only: Use this modifier if only the surgical care portion of the service is being billed.
10. Modifier 55 - Postoperative Management Only: Use this modifier if only the postoperative care portion of the service is being billed.
11. Modifier 56 - Preoperative Management Only: Use this modifier if only the preoperative care portion of the service is being billed.
12. Modifier 59 - Distinct Procedural Service: Use this modifier if a procedure or service is distinct or independent from other services performed on the same day.
13. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Use this modifier if the procedure is repeated by the same physician.
14. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Use this modifier if the procedure is repeated by a different physician.
15. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Use this modifier if the patient returns to the operating room for a related procedure during the postoperative period.
16. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period.
17. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon is required for the procedure.
18. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required for the procedure.
19. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon is required and a qualified resident surgeon is not available.
20. Modifier 99 - Multiple Modifiers: Use this modifier if multiple modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Medicare reimbursement for CPT code 22305, which pertains to the closed treatment of a spinal process fracture, depends on several factors including the specific Medicare plan, the setting in which the service is provided, and the geographic location. Generally, Medicare Part B may cover this procedure if it is deemed medically necessary and performed by a qualified healthcare provider.
To determine if CPT code 22305 is reimbursed by Medicare and the specific reimbursement amount, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or use the Medicare Administrative Contractor (MAC) resources for their region. The reimbursement amount can vary, but as of the latest updates, it typically ranges between $200 and $400. Providers should verify the exact amount through the MPFS or their MAC to ensure accurate billing and reimbursement.
For the most precise and up-to-date information, it is advisable to consult the Centers for Medicare & Medicaid Services (CMS) website or contact your local MAC.
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